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针刺穴位配合甲泼尼龙、环磷酰胺治疗重度膜性肾病35例疗效观察 预览

Curative effect observation of acupuncture with methylprednisolone and cyclophosphamide in the treatment of 35 cases of severe membranous nephropathy
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摘要 目的 观察针刺配合糖皮质激素和细胞毒药物治疗重度膜性肾病的效果.方法 选择2016年3月至2017年1月住院治疗的重度膜性肾病患者70例,按照随机数表法分为对照组和治疗组,每组35例患者,对照组在给予对症支持治疗的基础上使用甲泼尼龙口服与环磷酰胺进行静脉冲击量治疗:甲泼尼龙,口服,前8周以日量40 mg顿服,以后每4周减少10 mg,稳定在每日顿服10 mg,静脉输注环磷酰胺0.8克/次每周一次,在总剂量到达8 g时停止.治疗组在对照组基础上,再加用每天针刺肾腧、气海等穴位.对治疗的效果进行对比.结果 治疗之后,两组患者的抗磷脂酶A2受体抗体、24 h尿蛋白、血清白蛋白、三酰甘油、胆固醇、肾小球滤过率均出现了改善,治疗组患者改善的程度大于对照组患者,均差异有统计学意义(F不同时间点=20.356,13.684,21.139,9.682,12.253,18.647,P〈0.05,F两组比较=18.457,17.775,16.563,15.531,22.225,15.952,P〈0.05,F交互作用=11.159,12.645,14.368,10.329,19.952,12.265,P〈0.05),其中,治疗之后,对照组PLA2R抗体从(25.21±6.38)RU·mL-1下降为(12.75±6.09)RU·mL-1,24 h尿蛋白从(7.16±0.41)g下降为(3.98±0.46)g,肾小球滤过率从(68.12±8.35)mL·min-1升高为(90.33±11.89)mL·min-1,治疗组PLA2R抗体从(24.99±6.44)RU·mL-1下降为(8.92±4.16)RU·mL-1,24 h尿蛋白从(7.23±0.49)g下降为(3.05±0.52)g,肾小球滤过率从(69.69±8.94)mL·min-1升高为(98.36±8.54)mL·min-1,对照组治疗有效率(37.14%)低于治疗组(62.86%)(χ2=4.629,P〈0.05),治疗组治疗效果显著优于对照组,差异有统计学意义(Z=3.639,P〈0.05),两组消化道症状、糖耐量异常、肝损害等不良反应发生率差异无统计学意义(χ2=0.159,0.000,0.094,0.357,0.000,0.402,P〉0.05).结论 针刺穴位配合甲泼尼龙、环磷酰胺治疗重度膜性肾病的患者,可以显著改善患者的各项生理指标,提高治疗的效果,� To observe the effect of acupuncture combined with Glucocorticoid and Cytotoxic drugs in the treatment of severe membranous nephropathy.Methods Seventy patients with severe membranous nephropathy who were hospitalized from March 2016 to January 2017 were selected and randomly assigned into control group and treatment group ,35 patients in each group,On the basis of symptomatic support treatment,the patients in the control group were given oral methylprednisolone ,with a daily dose of 40 mg meals forthe first 8 weeks,and a decrease of 10 mg per week,and the daily dose of 10 mg was stable.Intravenous infusion of cyclophosphamide 0.8 g/times once a week,when the total dose reached 8 g,stopped.On the basis of the therapy of the control group was given acupunc -ture plus daily Shenshu,Qihai acupuncture.The treatment effects were compared between the two groups .Results After treatment,the data of PLA2R antibody,24 h urine protein,serum albumin,triglyceride, cholesterol and glomerular filtration rate in the two groups were improved.The improvement of the patients in the treatment group was greater than that in the control group .The differences of datawere statistically significant (F =20.356,13.684,21.139,9.682,12.253,18.647 for different time points,P 〈0.05;F =18.457,17.775,16.563,15.531,22.225,15.952 for comparison between the two groups ,P 〈0.05;F =11.159,12.645,14.368,10.329, 19.952,12.265 for interaction,P 〈0.05).After treatment,the PLA2R antibody in the control group decreased from (25.21 ±6.38)RU· mL-11 to (12.75 ±6.09) RU· mL-1 ,and the 24-hour urinary protein decreased from (7.16 ±0.41) g to (3.98 ±0.46) g and the glomerular filtration rate was (68.12 ±8.35) mL· min-1 increased to (90.33 ±11.89) mL· min-1 .The PLA2R antibody in the treatment group decreased from (24.99 ±6.44) RU· mL-1 to (8.92 ±4.16) RU· mL-1 ,and the 24 -hour urinary protein decreased from (7.23 ±0.49) g to (3.05 ±0.52) g,and glomerular filtration rate increased from (69.69
作者 李争 贾英辉 杨立豹 康锁彬 赵彦锁 LI Zheng, JIA Yinghui, YANG Libao, KANG Suobin, ZHAO Yansuo ( Department of Nephrology V, Shijiazhuang Kidney Disease Hospital, Shijiazhuang, Hebei 050061, China)
出处 《安徽医药》 CAS 2018年第6期1174-1178,共5页 Anhui Medical and Pharmaceutical Journal
基金 石家庄市科学技术研究与发展指导计划(161462323)
关键词 肾病综合征 针刺穴位 蛋白尿 甲泼尼龙 环磷酰胺 Nephrotic syndrome Acupuncture points Proteinuria Methylprednisolone Cyclophosphamide
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